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Prescribing Information
Covera-HS® (verapamil hydrochloride)
Overdosage
Return to the COVERA Product Center

Treat all verapamil overdoses as serious and maintain observation for at least 48 hours (especially sustained-release verapamil products), preferably under continuous hospital care. Delayed pharmacodynamic consequences may occur with the sustained-release formulations. Verapamil is known to decrease gastrointestinal transit time.

Treatment of overdosage should be supportive. Beta-adrenergic stimulation or parenteral administration of calcium solutions may increase calcium ion flux across the slow channel and have been used effectively in treatment of deliberate overdosage with verapamil. In a few reported cases, overdose with calcium channel blockers has been associated with hypotension and bradycardia, initially refractory to atropine but becoming more responsive to this treatment when the patients received large doses (close to 1 gram/hour for more than 24 hours) of calcium chloride. Verapamil cannot be removed by hemodialysis. Clinically significant hypotensive reactions or high degree AV block should be treated with vasopressor agents or cardiac pacing, respectively. Asystole should be handled by the usual measures including cardiopulmonary resuscitation.

Covera-HS® (verapamil hydrochloride)

COVERA-HS Indication and Important Safety Information
 

Please scroll to see the Indication below.

Important Safety Information

COVERA-HS is indicated for the management of hypertension and angina.

COVERA-HS is contraindicated in patients with severe left ventricular dysfunction, hypotension or cardiogenic shock, sick sinus syndrome, 2° or 3° AV block, or atrial flutter or atrial fibrillation and an accessory bypass tract.

The most commonly reported side effects of COVERA-HS (N=572) compared with placebo (N=261) were constipation (11.7%*/2.7%), headache (6.6%/7.3%), upper respiratory infection (5.4%/4.6%), dizziness (4.7%/2.7%), fatigue (4.5%/3.8%), edema (3.0%/3.1%), nausea (2.1%/1.9%), 1° AV block (1.7%/0.0%), elevated liver enzymes (1.4%/0.8%), and bradycardia (1.4%/0.4%).

Concomitant therapy with β-adrenergic blockers and verapamil may result in additive negative effects on heart rate, AV conduction, and/or cardiac contractility. There have been reports of excessive bradycardia and AV block, including complete heart block. The combination should be used only with caution and close monitoring.

Potential clinically significant interactions can be seen with concomitant therapy of verapamil with digitalis, disopyramide, flecamide, quinidine, lithium, carbamazepine and theophylline as well as other agents. These interactions may result in, but are not limited to, digitalis toxicity, significant hypotension, heart failure, or an increased concentration/sensitivity of the concomitant medication.

Concomitant therapy with oral hypertensive agents, including ACE inhibitors, will usually have an additive effect on lowering BP; patients receiving these combinations should be appropriately monitored.

Since verapamil is highly metabolized by the liver it should be administered cautiously to patients with hepatic impairment. In patients with severe hepatic dysfunction approximately 30% of the recommended dosage may be given; patients should be appropriately monitored.

*At the typical 240-mg dose, incidence of constipation was 7.2%.

Indication

COVERA-HS is indicated for the management of hypertension and angina.

COVERA-HS is contraindicated in:

  1. Severe left ventricular dysfunction
  2. Hypotension (systolic pressure less than 90 mmHg) or cardiogenic shock
  3. Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker)
  4. Second- or third-degree AV block (except in patients with a functioning artificial ventricular pacemaker)
  5. Patients with atrial flutter or atrial fibrillation and an accessory bypass tract (eg, Wolff-Parkinson-White, Lown-Ganong-Levine syndromes)
  6. Patients with known hypersensitivity to verapamil hydrochloride
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